The objective of thi proposal is to analyze changes in rural automobile related injuries and deaths associated with the initiation of an Emergency Medical Services System. Specifically, this proposed study will investigate changes in: 1) the time-to-treatment, 2) the hospital utilized in treatment, and 3) the type of injuries sustained in severe automobile accidents in a large rural area of southern Illinois (Region 5). Data for testing these changes will be obtained from coroner certificates of death, hospital records, and police reports. Analysis of these changes associated with initiation of an EMS system will enable rural areas in other geographic locations to anticipate the results of establishing a similar system or compare their system's results to that of this region's.